Page 115 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Shortcomings of the individual studies include retrospective study design, short or unclear length of follow up and inappropriate or no information on diagnostic methods to detect incisional hernias. Most importantly, available data derive from studies in which the same patient serves as case and control; i.e. the incidence of trocar-site hernia is measured for di erent sizes of trocars inserted at di erent abdominal sites in the same patient. This may impose signi cant bias, related to the strength of the abdominal wall and the wound repair mechanisms at varying sites of the abdominal wall, in particular the linea alba to other parts of the abdominal wall.
Helgstrand et al.(33) performed a systematic review on the incidence of trocar-site hernia. Although they found a risk reduction after sutured closure and a lower hernia rate for 5-mm versus larger diameter trocars, no meta- analysis was undertaken. The poor quality and design of the majority of the included reports preclude further in-depth evaluation for supporting evidence. No RCT’s have investigated the incidence of trocar-site hernia after insertion of blunt versus bladed trocars and no RCT’s or case-control studies have investigated the incidence of trocar-site hernia with reference to trocar size or diameter. Available data derive from univariate and multivariate analyses of cohort studies, which have investigated the e ect of potential risk factors for trocar-site hernia. Obesity, age above 60 years diabetes, long duration of surgery, and the need for fascia enlargement for specimen extraction were identi ed as risk factors for the development of trocar-site hernia(120, 136).
5
EHS guidelines
Statement
For laparoscopic procedures, using the smallest trocar size adequate for the procedure is suggested.
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Weak
Statement
For laparoscopic procedures, suturing the fascial defect, if trocars larger than or equal to 10 mm have been used, in the presence of established risk factors for incisional hernia formation is suggested.
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weak
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